Individual
MR. FAY ALLEN GOODALL
Active
Individual
MR. FAY ALLEN GOODALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT 10062
CA
225100000X
Physical Therapist
Primary
PT-286
ID
225100000X
Physical Therapist
PT00002838
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010019002
REGENCE BLUE SHIELD
ID
05
—
002609200
—
ID
01
—
2937
WASHINGTON LABOR & INDUST
WA
01
—
4004
STATE INSURANCE FUND
ID
01
—
82040818683854A003
TRICARE
—
01
—
T-5345
BLUE CROSS
ID
Enumeration date
05/01/2007
Last updated
04/26/2021
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